Diastema – the visible interdental interval dividing the central cutters top (is more rare – lower) a tooth alignment. Diastema not only represents an esthetic shortcoming, but also promotes violation of the speech, emergence of communicative and psychological difficulties. Specification of the reasons and the anomalies accompanying a diastema is carried out by means of dental survey, an intra oral X-ray analysis, an orthopan-tomography, studying of diagnostic models of jaws. Treatment of a diastema can be performed therapeutic (esthetic restoration), orthopedic (crowns, vinira), surgical (plasticity of a bridle of an upper lip or language), orthodontic (vestibular plates, briquettes) by methods.
Diastema – the abnormal provision of the central cutters which is characterized by existence between them a free interval. The interdental crack at a diastema can reach size from 1 to 10 mm (on average 2-6 mm). Diastema is among the most frequent zubochelyustny deformations which occurs approximately at 8-20% of the population. In most cases the interdental crack settles down between the top cutters, however can meet also in the lower tooth alignment. Diastema is often combined with other anomalies of situation, the sizes and shapes of teeth and therefore demands an integrated approach to a solution from therapeutic and surgical stomatology, orthodontics and orthopedics.
The analysis of clinical observations shows that heredity acts as the most frequent reason of formation of a diastema: in families with genetic predisposition about 50% of relatives I have this defect of tooth alignments.
The essential part in emergence of a diastema is assigned to anomalies of a bridle, such as short bridle of language, low attachment of a bridle of an upper lip, massive bridle of an upper lip, etc. Besides, the diastema can arise in the presence of the accessory impacted teeth, a mikrodentiya, a partial or multiple edentia, late eruption of second teeth, tumors of jaws (odontoma), a crevice of an alveolar shoot.
Various addictions (long sucking of a pacifier, biting of handles, pencils and other objects, onikhofagiya, habit to gnaw ave. sunflower seeds) can become the reason not only diastema, but also turn of the central cutters on a vertical axis.
Classification of a diastema
First of all, distinguish a false and true diastema. The false diastema is characteristic of the period of change of a temporary bite with constant. This state, normal, natural to children's age. Usually by the time of the end of change of teeth of a diastem it is closed independently. The true diastema is observed in a constant bite and does not disappear without the special dental help.
Taking into account an arrangement of an interdental interval the planes of a diastem can be rather median symmetric and asymmetric. At symmetric type of a diastema both central cutters are displaced lateralno on identical distance; at asymmetric – one cutter is located normally, and another – is considerably displaced in a lateral position.
According to other classification, allocate diasty three types:
- with a lateral inclination of crowns of the central cutters; at the same time fangs are located correctly;
- with the lateral case shift of the central cutters;
- with a medial deviation of crowns and a lateral deviation of roots of the central cutters.
At all kinds of a diastema the normal provision of crowns of cutters (without turn on an axis), turn of crowns of cutters on an axis in the vestibular or oral direction can take place.
All forms of a diastema represent the defect of a tooth alignment expressed in a varying degree. However some owners of a diastema are inclined to consider it not an esthetic shortcoming, and rather certain "highlight" of appearance and do not see need for the dental help.
Nevertheless, the interdental crack between the central cutters seldom happens rather narrow and parallel. Much more often at the expense of a deviation of the central cutters it has triangular shape with the top turned to a gum or a cutting edge of teeth. Besides, the diastema is often accompanied by a powerful bridle of an upper lip which fibers are attached to a crest of an alveolar shoot and are interwoven into a reztsovy nipple, and also tooth anomalies (trema, a mikrodentiya, an edentia, turn of cutters on an axis), the wrong bite (distalny, mezialny, open, deep, cross). Therefore many people from diastemy feel psychological and physical discomfort, hesitate of the appearance and a smile. Existence of a diastema favors to development of a periodontal disease in frontal teeth.
Diastema can be followed by violation of a sound pronunciation (a mechanical dislaliya) – a prisvistyvaniye, lisping that in turn creates difficulties of speech communication, limits the choice of the sphere of professional activity and demands the help not only of the stomatologist, but also the logopedist.
Diagnostics of a diastema
Presence at the patient of a diastema comes to light during visual survey of an oral cavity. Nevertheless, specification of the reasons and a type of a diastema requires carrying out a number of additional diagnostic procedures: definitions of a bite, aim X-ray analysis, orthopan-tomography, removal of molds, production and studying of diagnostic models of jaws. In the analysis of data situation, a form, an inclination of cutters and roots is considered; condition of bridles; size of an interdental interval and symmetry of a diastema; character of a bite, existence of the impacted teeth etc.
The problem of the choice of an optimum method of elimination of a diastema has to be solved jointly, with involvement of various experts: stomatologists-therapists, surgeons, orthodontists, orthopedists.
Treatment of a diastema
Depending on an etiology and a kind of a diastema treatment can be performed by means of therapeutic, orthopedic, orthodontic, surgical methods, and also their combination. Elimination of a diastema by method of cosmetic restoration assumes closing of an interdental interval by means of the composite (direct) vinir made of a light-cured composite directly in the stomatologist's office for one visit.
The orthopedic method of elimination of a diastema is based on use for closing of an interdental interval of ceramic vinir or fixed artificial limbs (artificial metalacrylic, ceramic-metal, tselnokeramichesky crowns).
If anomalies of a form and an attachment of bridles act as prichinoobuslovlivayushchy factors of a diastema, surgical treatment - plasticity of a bridle of lips or language is carried out. In some cases removal of the impacted and dihundred-pyrobathing teeth, carrying out an interroot kompaktosteotomiya with the subsequent orthodontic correction is required. The orthodontic method of elimination of a diastema consists in movement of provision of cutters by means of removable devices (vestibular plates) or the fixed equipment (breket-systems).
Forecast and prevention of a diastema
The variety of clinical forms of a diastema dictates need of drawing up the individual plan of treatment for each case, accurate justification of criteria of the choice of optimum methods and the sequence of stages of treatment. Such approach allows to achieve optimum esthetic results of treatment of a diastema, elimination of shortcomings of a sound pronunciation and psychological complexes.
The basic rules of prevention of a diastema come down to an exception of harmful oral habits, elimination of the accompanying maxillofacial anomalies, regular observation at the stomatologist.